Individual research recommendation details

Recommendation ID

NG100/5

Question

Management of poor prognosis:- What is the clinical and cost effectiveness of managing RA with a poor prognosis (identified as presence of anti-cyclic citrullinated peptide [CCP] antibodies or evidence of erosions on X-ray at diagnosis) with a different strategy from that used for standard management of RA?

Any explanatory notes
(if applicable)

Why this is important:- Current recommendations suggest all people with RA should be offered the same management; however clinical experience suggests that the condition responds less well in some people and some suffer progressive radiographic damage and impaired function despite standard management. Several factors have been identified in the literature that, if present and identified early in the course of the disease, may predict a poor prognosis (greater radiographic progression).
These include anti-CCP antibody positivity and the presence of radiographic erosions at baseline. At present it is unclear whether people with poor prognostic markers should have different management early in the disease, and whether this would improve radiographic and functional (HAQ) outcomes in this group.

Source guidance details

Comes from guidance

Rheumatoid arthritis in adults: management

Number

NG100

Date issued

July 2018

Other details